Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
18849599 Proinflammatory cytokine profiles of patients with elderly-onset rheumatoid arthritis: a c 2009 BACKGROUND: Little is known about the differences in the immunopathogenesis between elderly-onset rheumatoid arthritis (EORA) and younger-onset RA (YORA) and the factors responsible for their clinical characteristics. OBJECTIVE: It was the aim of this study to investigate proinflammatory cytokines of EORA patients and compare them with those of YORA patients. METHODS: Serum levels of interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma were determined by cytometric bead array in 86 patients with active EORA, in 76 patients with active YORA and in 30 healthy controls. Disease activity of RA was assessed using the 28-joint disease activity score. Erosion scores were recorded using a modified version of the Sharp method. Levels of anti-cyclic citrullinated peptide antibodies were determined by ELISA, and levels of rheumatoid factor-IgM and C-reactive protein were measured by nephelometry. RESULTS: A higher proportion of men and a higher frequency of acute onset with constitutional symptoms and comorbidities were observed in EORA compared with YORA patients. Increased levels of serum IL-1beta, IL-6, TNF-alpha, IFN-gamma and IL-8 were positively correlated with the 28-joint disease activity score, and elevated levels of IL-1beta and TNF-alpha were positively correlated with erosion scores for both groups of RA patients. Significantly higher IL-6 levels and lower TNF-alpha levels were found in EORA compared with YORA patients. Higher levels of serum IL-6 were found in EORA patients with polymyalgia rheumatica-like symptoms than in those without and were also noted in male patients with EORA compared with female patients. Multivariate analysis showed that high levels of TNF-alpha were associated with the occurrence of constitutional symptoms, and high levels of IL-1beta were associated with the presence of anti-cyclic citrullinated peptide antibodies in EORA patients. CONCLUSION: EORA patients appear to have differences in clinical characteristics and the patterns of proinflammatory cytokines when compared with YORA patients.
18413345 Morning stiffness and its influence on early retirement in patients with recent onset rheu 2008 Jul OBJECTIVE: To describe the association between morning stiffness (MS) and early retirement in patients with early RA. METHODS: The study used data from a prospective RA cohort of 916 RA patients with disease duration
16960927 Can severity be predicted by treatment variables in rheumatoid arthritis administrative da 2006 Oct OBJECTIVE: Administrative data bases provide rapid access to data regarding treatment and morbidity of rheumatoid arthritis (RA). A serious limitation of administrative data bases is the lack of information regarding RA severity, as in the case of lymphoma, where RA severity may contribute to the cause of the adverse outcome. We examined whether treatment variables could predict RA severity. METHODS: We studied 7541 patients with RA who were participating in a longitudinal study of RA outcomes. Disease severity was determined by the Patient Activity Scale (PAS), which represents on a 0 to 10 scale the mean of 0-10 standardized values of pain (by visual analog scale), patient global severity, and the Health Assessment Questionnaire. We tested the ability of disease modifying antirheumatic drugs (DMARD) and biologic treatment variables and the lifetime number of these treatments to predict severity status. The receiver-operating characteristic (ROC) area under the curve (AUC) was used to describe the association between severity and treatment variables. RESULTS: There was little difference in PAS scores between various treatments and treatment groups, including scores of the 18.3% of patients receiving no DMARD or biologic therapy. The ROC AUC to distinguish PAS scores above and below the median was 0.64 (60.5% correctly classified) and was 0.70 (67.2% correctly classified) in distinguishing first compared to fourth quartiles PAS scores. CONCLUSION: Treatment variables do not accurately or usefully identify severity status. As a corollary, there is little difference in severity between patients receiving different treatment regimens, and actual measures of severity rather than treatment surrogates are required to assess RA severity.
17665488 Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and 2007 Aug 15 OBJECTIVE: To determine the effects of participation in a low-impact aerobic exercise program on fatigue, pain, and depression; to examine whether intervention groups compared with a control group differed on functional (grip strength and walk time) and disease activity (total joint count, erythrocyte sedimentation rate, and C-reactive protein) measures and aerobic fitness at the end of the intervention; and to test which factors predicted exercise participation. METHODS: A convenience sample of 220 adults with rheumatoid arthritis (RA), ages 40-70, was randomized to 1 of 3 groups: class exercise, home exercise using a videotape, and control group. Measures were obtained at baseline (T1), after 6 weeks of exercise (T2), and after 12 weeks of exercise (T3). RESULTS: Using structural equation modeling, overall symptoms (latent variable for pain, fatigue, and depression) decreased significantly at T3 (P < 0.04) for the class exercise group compared with the control group. There were significant interaction effects of time and group for the functional measures of walk time and grip strength: the treatment groups improved more than the control group (P
16414461 Augmented subscapularis muscle transposition for rotator cuff repair during shoulder arthr 2006 Jan The effectiveness of rotator cuff repair by augmented subscapularis transposition via the Leeds-Keio artificial ligament was evaluated in patients with rheumatoid arthritis undergoing total shoulder arthroplasty. The minimum follow-up period was 2 years. Final clinical scores (Hospital for Special Surgery scoring system) and the incidence of radiolucency and upward migration of shoulder components in 20 shoulders with rotator cuff repair by augmented subscapularis transposition were superior to those of 19 shoulders with cuff repair by subscapularis transposition alone and similar to those of 22 shoulders with intact rotator cuffs. In shoulders with augmented subscapularis transposition and intact cuffs, clinical scores continued to improve even after the first postoperative year. Our augmented subscapularis transposition did not increase postoperative complications. We conclude that cuff repair by augmented subscapularis transposition is an acceptable alternative for repairing a supraspinatus or supraspinatus and infraspinatus rotator cuff defect in rheumatoid arthritis patients undergoing total shoulder arthroplasty.
16652420 Survival analysis and longterm results of elbow synovectomy in rheumatoid arthritis. 2006 May OBJECTIVE: To evaluate longterm results and survival rate of open synovectomy of the elbow joint in patients with rheumatoid arthritis (RA). METHODS: Between 1986 and 2000, synovectomy of the elbow was performed on 103 joints in 92 patients with RA. Eighty-five joints were included in this study. Mean age at time of surgery was 52 years (range 13 to 62 yrs). On 13 elbows with Larsen stage I and II disease, early synovectomy preserving the radial head was performed; in 72 cases with Larsen stage III and IV, late synovectomy with radial head resection was necessary. RESULTS: In early synovectomy, one joint received prosthetic joint replacement and 2 joints underwent resynovectomy a mean of 9 years after primary surgery. The survival rate (no further operations) was 91% after 5 years and 78% after 10 years. In late synovectomy, 16 elbow joints were operated again a mean of 4.6 years after primary surgery (10 prosthetic joint replacements, 2 resection interposition arthroplasties, 4 resynovectomies). Survival rate was 82% after 5 years and 66% after 10 years. Sixty-one elbows were examined clinically at a mean followup period of 8.7 years (range 2.8-17.3 yrs). There was a significant improvement of the Morrey score at followup, especially due to effective relief of pain. Improvement of joint motion was seen in late synovectomy for pronation and supination. The mean preoperative Larsen stage was 3.11, which decreased significantly to 3.66 at followup. CONCLUSION: Our findings suggest that synovectomy is a safe and effective procedure in differential treatment of RA of the elbow.
16395767 Systemic lupus erythematosus evolving into rheumatoid arthritis. 2006 Jan We describe 3 patients who presented with clinical and serological evidence of systemic lupus erythematosus (SLE) and 10 or more years later developed for the first time clinical and serological manifestations of rheumatoid arthritis (RA). Each patient now meets the American College of Rheumatology criteria for both SLE and RA.
17605816 Expert agreement confirms that negative changes in hand and foot radiographs are a surroga 2007 The objective of the present study was to test the hypothesis that experts recognize repair of erosions and, if so, to determine which, if any, morphologic features permitted them to recognize the repair. We also tested whether scoring by a standard method detected repair. Seven experienced readers of radiographs in rheumatoid arthritis were presented with 64 sets of single joints-of-interest at two time points, randomized and blinded for the correct sequence. The readers assessed which joint was better, and recorded whether any of six specific features were seen. Two independent readers, experienced in scoring by the van der Heijde-modified Sharp method who were not on the expert panel, then scored the complete films that included the joint-of-interest. The panel agreed very well on which of two joints was better, and, even though they did not know the true sequence, the panel accurately assigned a sequence slightly better than chance alone (58%) but worse than their agreement on which image was 'better or worse' (78%). The readers therefore indirectly assigned repair by choosing the second film as the best. Putative repair features were seen in cases of both repair and progression, and were not discriminatory. Similar results were obtained when the experts were presented with the entire hand or foot containing the joint-of-interest. In the third repair exercise, two independent readers who scored whole hands and feet using a standard method found a mean negative score in 22/60 joints-of-interest. All 22 joints were also scored as repair by the panel. Repair was detected reliably by a majority of the panel on viewing paired images based on a better/worse decision and assigning sequence in a set of images that were blinded for sequence by an independent project manager. In this test set of images, repair was manifested by a reduction in the size of erosion in many cases. Size was one feature that aided the experts to detect repair but cannot be the only one; the experts had to find other features to determine whether a smaller erosion was the first in a sequence of radiographs in a patient with progressive damage or was the second film in a patient exhibiting repair. The change in size of erosion was also picked up by independent readers applying the van der Heijde-modified Sharp scoring method and was reflected in their scores.
18649347 'It's quite hard to grasp the enormity of it': perceived needs of people upon diagnosis of 2008 Sep OBJECTIVES: The diagnosis of rheumatoid arthritis (RA) brings rapid pharmacological and multidisciplinary team interventions to address inflammatory processes and symptom management. However, people may also need support on the journey to self-management. The aim of this study was to explore what professional support patients feel they receive upon diagnosis, and what support they feel would be most helpful. METHODS: Two focus groups comprised patients with at least five years'; disease duration (n = 7), and patients more recently diagnosed (5-18 months, n = 5). The latter had attended at least two appointments in a rheumatology nurse specialist clinic during the previous year, aimed at providing support upon diagnosis. Transcripts were subjected to thematic analysis to identify common issues regarding support needs, which were then grouped into themes. Interviewing and analysis was performed by researchers not involved in clinical care. RESULTS: Four overarching themes emerged. 'Information' was needed about the symptoms of RA, its management and personal outcome, while 'Support' related to emotional needs ('It's quite hard to grasp the enormity of it'). Information and Support overlapped, in that patients wanted someone to talk to, and to be listened to. These two themes were underpinned by issues of service delivery: 'Choice' (patient or professional to talk to, groups, one-to-one) and 'Involvement' (holistic care, partnership), which overlapped in terms of the opportunity to decide when and which interventions to access. CONCLUSIONS: People with RA report not only informational, but also emotional support needs at diagnosis. The potential for delivering emotional support to patients around the time of diagnosis warrants further exploration.
19275464 Diagnosis and treatment of early active rheumatoid arthritis. 2008 Dec A 59-year-old patient comes to a community pharmacy with unexplained, worsening bilateral foot pain and inflammation. Following evaluation of the situation, the pharmacist suggests that the patient has rheumatoid arthritis (RA). After a visit and consultation with her physician, the patient begins a complicated, rapidly evolving therapeutic regimen for RA. Through extensive counseling and education, the pharmacist is able to help the patient better manage her new medication regimen and understand expected outcomes. Pharmacists can play a very active role in helping patients with RA manage their therapies to optimize health outcomes.
16504819 The definition and measurement of disease modification in inflammatory rheumatic diseases. 2006 Feb This article focuses on measures that are used to evaluate disease activity, damage, and function in three major inflammatory musculoskeletal disorders. The instruments used in rheumatoid arthritis, where most of the methodologic work has been done, are extensively discussed and instruments for the respective domains in psoriatic arthritis and ankylosing spondylitis are likewise presented.
18771585 Prognostic factors of 10-year radiographic outcome in early rheumatoid arthritis: a prospe 2008 INTRODUCTION: The objectives of this study were to determine the predictive factors of long-term radiographic outcome of rheumatoid arthritis (RA) and to describe the relationship between joint damage and disability over the course of the disease. METHODS: A cohort of 191 patients with early RA referred from primary care physicians were prospectively followed for 10 years. To determine the predictive factors of radiographic outcome, univariate analysis of the relationship between baseline values and outcome measures was undertaken using a chi-squared or Fisher's exact test. Stepwise multiple logistic regression was also performed to select independent prognostic factors. RESULTS: From data available for 112 patients, univariate analysis revealed a total Sharp score at 10 years that was significantly correlated with erythrocyte sedimentation rate (ESR), presence and level of IgA rheumatoid factor, presence of an anti-citrullinated protein antibody (ACPA), serum level of matrix metalloproteinase-3 and radiographic score at baseline. Logistic regression identified the baseline erosion score to be the most important baseline parameter as an independent prognostic factor of total radiographic score at 10 years (odds ratio = 5.64; 95% confidence interval = 1.78 to 17.86). After excluding radiographic scores from the entry parameters, the presence of ACPA and ESR were also predictive of the final total Sharp score. The Health Assessment Questionnaire (HAQ) score was strongly correlated with disease activity parameters, such as disease activity score and pain, at baseline and at three, five and 10 years. No correlation was found between total radiographic Sharp score and HAQ score throughout the study. CONCLUSIONS: In this prospective study, baseline radiographic score, ESR and ACPA were the best predictive factors of 10-year radiographic outcome in early RA. HAQ disability was associated with disease activity throughout the 10-year follow-up but not with joint damage. This discrepancy with previous reports may be due in part to the early start of therapy with disease-modifying anti-rheumatic drugs.
17516624 Quantification of reduced health-related quality of life in patients with rheumatoid arthr 2007 Jun OBJECTIVE: To compare levels of health-related quality of life (HRQOL) among patients with rheumatoid arthritis (RA) to those of the general population. METHODS: Disease burden was assessed using a generic health status instrument (Medical Outcome Study Short Form-36) for measurements of HRQOL and SF-6D to calculate utility scores in representative patients aged 20 to 79 years from the Oslo RA Register (n = 1052), and in individuals in the general population (n = 2323). Comparisons were performed with respect to sex and age, and standardized difference scores (s-scores) were calculated for comparisons with the norm. RESULTS: HRQOL in patients with RA was reduced compared to the general population on all scales of the SF-36 for both males and females and for all age groups. s-scores adjusted for age and education ranged from -1.39 for physical functioning to -0.27 for mental health. The overall difference in utility was 0.16 and ranged from 0.13 (in female patients below 50 yrs) to 0.20 (patients 50-60 years). This implies that RA of 1 year duration entails a disease burden of 14-20 quality-adjusted life-years in 100 RA patients. CONCLUSION: RA inflicts a substantial disease burden, and the disease affects all HRQOL dimensions as measured by the SF-36 in both sexes and in all age groups. Physical functioning is predominantly affected, but RA has social and mental consequences.
19371393 Treatment-induced stable, moderate reduction in blood cell counts correlate to disease con 2009 May BACKGROUND: Treatment of rheumatoid arthritis (RA) has become more intensive, thereby raising concerns regarding toxicities, including leucopenia. The objective was to analyse cell counts obtained as routine surveillance for adverse effects to assess the effect of intensive treatment and treatment dosage and to examine correlations to disease activity scores. METHODS: Patients with early RA were treated with combinations of disease-modifying anti-inflammatory drugs according to pre-defined rules, with dose adjustments contingent on residual disease activity and tolerance. RESULTS: Mean leucocyte, neutrophil and platelet counts fell with levels that correlated to disease activity scores. The strongest correlation was between platelets and disease activity scores. There was a modest, inverse correlation between methotrexate dose and monocyte and lymphocyte counts. No serious toxicity associated with the therapy was seen. CONCLUSION: Moderate reductions in cell counts are well tolerated in RA and appear to contribute to disease control.
17392351 Pain and psychological health status over a 10-year period in patients with recent onset r 2007 Sep OBJECTIVE: To examine rheumatoid arthritis (RA) with short disease duration over 10 years, and to identify factors that are associated with the course of pain, depression and anxiety. METHODS: A cohort of 238 patients with RA (age 20-70 years, mean disease duration 2.3 years, 68% rheumatoid factor positive) was followed with assessments at baseline and after 1, 2, 5 and 10 years. Self-reported health status was assessed by pain on a 100 mm visual analogue scale, the Arthritis Impact Measurement Scales (AIMS), the 28-item version of General Health Questionnaires, and the Health Assessment Questionnaire. We also examined the erythrocyte sedimentation ratio, grip strength (kg) and radiographic progression of the hands (van der Heijde modified Sharp score). Repeated measures analyses of variance were used to explore the effect of time on measures of outcome among completers, whereas repeated measures analyses using a mixed model were applied to identify factors that were longitudinally associated with pain, depression and anxiety. RESULTS: At the various assessment points 30% had a visual analogue scale pain score of > or =40 mm, 5-13% had an AIMS depression score of > or =4.0 and 20-30% had an AIMS anxiety score of > or =4.0. The perceived level of pain was explained longitudinally by anxiety, disease activity, physical function and female gender, depression by high disease activity and anxiety, whereas anxiety was explained by low disease activity and depression. CONCLUSION: More patients had increased levels of anxiety (20-30%) than increased levels of depression (5-13%). Several factors, including anxiety, but not depression, were associated with the course of pain.
16953393 Outcome of patients with reactive amyloidosis associated with rheumatoid arthritis in dial 2006 Oct The aim was to analyze the clinical outcome of a group of 51 patients diagnosed with systemic amyloidosis associated with rheumatoid arthritis who received hemodialysis (HD) as renal replacement therapy. We monitored the clinical course of the disease and factors that could influence survival. Determination of the onset of the underlying disorder was made retrospectively by reviewing the patient's chart when a diagnosis of amyloid was confirmed. During a 96.9 person-year follow-up, 42 patients died. Survival of these 51 patients from the initiation of HD at 251 days was 50%. Poor prognosis in amyloid patients was mainly due to a large number of sudden deaths immediately following HD therapy. Out of 51 patients 21 needed unplanned initiation of HD. The unplanned initiation was significantly associated with poor survival. Seventy-five percentile of creatinine clearance (Ccr) was 9.7 ml/min, and 75% of these patients who initiated HD had highly impaired renal functional states. These data indicated that amyloidotic patients with HD showed a high mortality rate; therefore, planned initiation of HD was highly recommended to improve the patient's survival. Particular attention was given to the Ccr levels, because the levels of serum creatinine may not be a useful marker for some patients with amyloidosis.
17932812 RNAi in arthritis: prospects of a future antisense therapy in inflammation. 2007 Oct Rheumatoid arthritis is a chronic autoimmune disease of unknown etiology that is characterized by chronic systemic inflammation, mainly affecting the joints, leading to subsequent destruction of the cartilage and bone. RNA interference (RNAi) has been used as a remarkable new research tool to control gene expression and is ultimately envisioned to be useful in clinical treatments. The potential application of RNAi-based therapy in rheumatoid disorders is evaluated. The first successful attempts at TNFalpha silencing by local and systemic delivery of small interfering RNA in experimental arthritic models are discussed. In addition, RNAi and current biotherapies used in the clinic are compared and contrasted.
17183623 Sustained remission and reduced radiographic progression with combination disease modifyin 2007 Feb OBJECTIVE: To study sustainability of remission and good treatment response, and the association of both with radiographic progression, in early rheumatoid arthritis (RA) in the Finnish Rheumatoid Arthritis Combination Therapy trial (FIN-RACo). METHODS: Patients were randomized to receive either a combination of disease modifying antirheumatic drugs (DMARD; COMBI, n = 97) or a single DMARD (SINGLE, n = 98). Remission was defined according to modified American College of Rheumatology (ACR) remission criteria and Disease Activity Score 28 joint count (DAS28) < or = 2.6, and sustained remission as presence of remission at 6, 12, and 24 months. Good treatment response was defined as DAS28 (3/4) 3.2 and decrease of DAS28 >1.2. RESULTS: In 169 patients with complete data, 33 (42%) COMBI and 18 (20%) SINGLE patients achieved modified ACR remission at 2 years, which was sustained in 11 (14%) COMBI and 3 (3%) SINGLE patients. Fifty-four (68%) COMBI and 37 (41%) SINGLE patients were in DAS28 remission at 2 years, which was sustained in 40 (51%) COMBI and 14 (16%) SINGLE patients. Good treatment response was sustained in 67% of COMBI and 27% of SINGLE patients. Over 2 years, the Larsen score increased by a median of 1 (95% CI 0-2) in patients in sustained DAS28 remission compared to 4 (95% CI 2-16) in patients who were in DAS28 remission at 6 months but lost it later; and by 6 (95% CI 2-10) in patients who were not in remission at 6 months. CONCLUSION: A remarkable proportion of patients with early RA treated with combinations of DMARD were in remission at 2 years, and remission was more often sustained compared to patients treated with a single DMARD. Sustained remission protects against radiographic joint damage.
17428216 The impact of arthritis on daily life with the patient perspective in focus. 2007 Mar BACKGROUND: Rheumatoid arthritis (RA) often has a major impact on many areas of an individuals' life. The unpredictability of the prognosis as well as the day-to-day symptoms make it impossible to plan ahead. The aim of this study was to identify the domains of concern in the early course of RA. METHODS: Interviews were carried out according to the focus group method. Twenty-three patients with RA, aged between 27 and 67 years and with a disease duration ranging from 1 to 5 years, were included. Four groups were established, the composition of which was based on age, gender and social situation. RESULTS: Arthritis had a major impact on daily life of the patients, especially on the way they performed activities. It also strongly influenced their mood and social life. The participants tried to cope by 'dosing their activities', 'using new strategies' or to 'stretching their limits'. Their sense of helplessness and uncertainty led to both 'anger' and 'depression'. When activities could no longer be maintained, the role positioning in the family also changed. CONCLUSION: The results of this study support the view that more psychosocial support is required to encourage the recently diagnosed RA patient in the new situation of having a chronic disease.
17412740 QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in s 2007 Nov OBJECTIVE: To conduct a cross-sectional review of non-selected consecutive outpatients with rheumatoid arthritis (RA) as part of standard clinical care in 15 countries for an overview of the characteristics of patients with RA. METHODS: The review included current disease activity using data from clinical assessment and a patient self-report questionnaire, which was translated into each language. Data on demographic, disease and treatment-related variables were collected and analysed using descriptive statistics. Variation in disease activity on DAS28 (disease activity score on 28-joint count) within and between countries was graphically analysed. A median regression model was applied to analyse differences in disease activity between countries. RESULTS: Between January 2005 and October 2006, the QUEST-RA (Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis) project included 4363 patients from 48 sites in 15 countries; 78% were female, >90% Caucasian, mean age was 57 years and mean disease duration was 11.5 years. More than 80% of patients had been treated with methotrexate in all but three countries. Overall, patients had an active disease with a median DAS28 of 4.0, with a significant variation between countries (p<0.001). Among 42 sites with >50 patients included, low disease activity of DAS28 50% of patients had high disease activity of DAS28 >5.1. CONCLUSIONS: This international multicentre cross-sectional database provides an overview of clinical status and treatments of patients with RA in standard clinical care in 2005-6 including countries that are infrequently involved in clinical research projects.